High deductible health plans (HDHPs) are one of the most important and controversial developments in U.S. health care in the past decade. Using deductibles of at least $1,000 per individual and $2,000 per family, these plans attempt to control health insurance costs by increasing patient responsibility for managing health care spending. Increasing numbers of adults and children are being enrolled in high-deductible health plans, but scant information exists about their effects on families. This innovative project will explore how HDHPs affect the processes of decision making on health care use, including knowledge, attitudes, cost-mitigating strategies, and perceived burden. We will: (1) Develop new measures to describe health care decision-making and perceived burden among families in HDHPs; (2) Refine these measures in a validation survey of families in HDHPs; and (3) Conduct an exploratory study of decision-making patterns and health care use in HDHPs by families with low socioeconomic status or chronic conditions. In Aim 1, we will conduct a focus group study to identify and refine new concepts and measures on decision-making on health care use. Aim 2 entails a validation survey based on telephone interviews with parents and matched claims data on health care use. Analyses will evaluate test-retest reliability and construct validity. In Aim 3, we will field the resulting instrument in additional families and conduct exploratory analyses to generate hypotheses for further study. We will compare decision-making patterns and health care use in HDHPs between families with low socioeconomic status or chronic conditions and families without these risk factors. For example, we will evaluate whether parents with lower educational levels are more likely to forego preventive care than other families. The proposed research is innovative in its focus on family decision-making under modern high deductible arrangements. The results will help policymakers and families improve the effective design and use of cost-sharing arrangements. They will also create essential building blocks for future studies of how cost containment approaches affect the health of children, parents, and families. [unreadable] [unreadable] [unreadable]